POS0314 CAN METHOTREXATE INFLUENCE SEXUAL DYSFUNCTION IN MALE PATIENTS: ANALYSIS OF THE IIEF5 QUESTIONNAIRE AND HORMONAL STATUS
Authors: F. Natalucci, S. Bisseron, T. Sokolova, A. Avramovska, D. Maiter, P. Durez
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Methotrexate (MTX) is the anchor drug of Rheumatoid Arthritis (RA) treatment. It is a safe and handy drug, but it has several well-known side effects mainly not severe such as nausea, fatigue, alopecia, or an increase in transaminases. In the last years, sexual dysfunction has been reported as a rare adverse effect of MTX therapy. <h3>Objectives</h3> To explore this, the aim of this study is to evaluate the impact of MTX on erectile function in male patients through the IIEF5 questionnaire and hormonal dosage. <h3>Methods</h3> Male patients affected by inflammatory arthritis (Rheumatoid Arthritis or Psoriatic Arthritis [PsA]) according to the 2010 EULAR/ACR diagnostic criteria for RA and the 2006 CASPAR criteria for PsA and treated with chronic MTX were enrolled. Age-matched patients affected by chronic arthritis not treated with MTX were enrolled as control. Each patient underwent blood collection for a complete serum sexual hormone evaluation. IIEF5 questionnaire which consists of 5 items with a maximum score of 25 was administered to the patients. <h3>Results</h3> 109 patients were included, 77 in the MTX group (Group A) and 32 in the control group (Group B). The clinical and demographic features of both groups are reported in Table 1. Among the MTX group, 61 have a RA diagnosis, while the remaining 18 were affected by PsA. The median disease duration of RA and PsA patients was respectively 108 months (IQR 138) and 66 months (IQR 114). The median MTX dose was 10 mg (IQR 7.5) with a median MTX duration therapy of 8 years (IQR 17). The total IIEF5 score was lower in patients treated with MTX compared to the control group without reaching a statistically significant result (19 [IQR 11] <i>versus</i> 20 [IQR 7.7]; p=0.15, Graph 1A). However, when comparing the IIEF5 score between MTX exposed versus non-exposed patients stratifying by years of treatment, the total IIEF5 score of patients treated with MTX ≥ 5 years was statistically significantly lower when compared to those non MTX- exposed patients (17 [IQR 15] <i>versus</i> 20 [IQR 7.7]; p=0.04) and compared to those treated for &lt; 5 years (17 [IQR 15] <i>versus</i> 20 [IQR 7]; p=0.01) (Graph 1B). In the univariate analysis, a negative correlation between the total IIEF5 score and MTX exposure (years) has been identified (r= - 0.20 CI [-0.38 - -0.04]; p= 0.039). Age was the variable whit the strongest negative association with the IIEF5 score (r= - 0,42 CI [-0.57 to - 0.25]; p&lt; 0.0001). MTX exposure was still associated with a lower IIEF5 score when adjusted for age (β Estimate= -2,63; CI [-5,13 to -0,13]; p=0,0391). Among the other variables, LH (r=-0,24; CI [-0,42 to -0,04]; p=0,01), FSH (r=-0,21; CI [-0,39 to -0,006]; p=0,04) and E2 (r=-0,21; CI [-0,40 to -0,009]; p=0,03) negatively correlated whit IIEF5 score while DHEA, was the only with a weak positive association (r=0,22; CI [0,02 to 0,40]; p=0,03). Patients affected by arterial hypertension and hypercholesterolemia showed lower scores compared to non-affected patients (p=0.04; p=0.03; p=0.045). In the multivariate analysis, age was the only factor associated with a decrement of IIEF5-score (β -0,21 [-0,32 to -0,094]; p=0,0005). <h3>Conclusion</h3> Long-term MTX exposure was associated with sexual dysfunction reported by a lower IIEF5 score in male patients adjusted for age. The preliminary results need to be confirmed in larger prospective studies. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.